Provider Demographics
NPI:1730138785
Name:TANFULLA, LUCIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:
Last Name:TANFULLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LUCIANO
Other - Middle Name:
Other - Last Name:TANFULLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1600 S ANDREWS AVE
Mailing Address - Street 2:4TH FLR NICU
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2510
Mailing Address - Country:US
Mailing Address - Phone:954-355-5870
Mailing Address - Fax:954-355-5872
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:4TH FLR NICU
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5870
Practice Address - Fax:954-355-5872
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 563842080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251451600Medicaid